Solid-variant aneurysmal bone cysts in the craniofacial skeleton: the role of genomic analysis

Long-Term Outcomes of Temporal Bone Aneurysmal Bone Cysts: Ambispective Study With Systematic Review and Pooled Analysis

OBJECTIVE

To analyse the clinical, radiological, and surgical management of temporal bone aneurysmal bone cysts (ABCs) and identify factors affecting outcomes.

STUDY DESIGN

Ambispective study.

SETTING

A single tertiary care institution.

METHODS

This study reviewed 6 cases of temporal bone ABCs treated between 2017 and 2024. Patient demographics, clinical presentation, imaging characteristics, surgical details, and outcomes were collected. A systematic review of the literature was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, to compare institutional cases with published data. Statistical analyses were performed to identify predictors of treatment success and recurrence.

RESULTS

The cohort had a mean age of 27.5 years. Presenting symptoms included scalp swelling, aural fullness, tinnitus, and hearing impairment. Imaging showed expansile lesions with fluid-fluid levels and bone erosion. All patients underwent gross total excision, with a mean intraoperative blood loss of 230.6 ml. One patient experienced temporary grade III facial palsy, which resolved within 3 months. No recurrences were observed during a mean follow-up of 35 months. A pooled analysis of 45 cases from the literature revealed that swelling in the temporal region was the most common presenting feature, and gross total resection was the most frequently employed treatment. Recurrences were rare and typically associated with subtotal resections or advanced-stage tumors.

CONCLUSION

Surgical excision, particularly gross total resection, is the treatment of choice for temporal bone ABCs, with a low recurrence rate. Stage and extent of resection are critical factors in predicting outcomes. This study enhances understanding of the diagnostic and therapeutic approaches for this rare condition.

The treatment of aneurysmal bone cysts

PURPOSE OF REVIEW

Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature.

RECENT FINDINGS

In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children.

SUMMARY

Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.